Fire Island Yacht Club Application

Fire Island Yacht Club - Membership Form

Everyone is welcome to join. No membership fees, no commitments, no worries. ( * = required )

Captain's Name: *
First

Last
Email: *
you@yourdomain.com

Birthday (So we can celebrate!):
mm/dd only, not the year
Phone Number: * ### ### ####

First Mate:
Wife/Husband/Significant Other
Crew Members:
List crew members separated by commas (Jane, Bobby, Tommy, Casey, etc...)
Address: *
Street Address

Address Line 2

City

State
Zip Code

Country
Boat Info:
Boat Name

Boat Length (feet)

Number of years boating
Boat Make

Home Port / Marina
Referred by: *
Enter name of FIYC member that referred you
Message:
* I've read & accept the user agreement & privacy policy. (We'll never share your information.)